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General NPI Number Information
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NPI Number | 1316057441
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Entity Type | Organization
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Legal Business Name | DIGESTIVE DISEASES ASSOCIATES OF TAMPA BAY LLC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | 876 S PARSONS AVE
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City | BRANDON
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State | FL
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Zip | 33511-6007
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Country | US
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Telephone | 813-653-3359
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Fax | 813-662-9639
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Provider Business Mailing Address
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Address Line | 876 S PARSONS AVE
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City | BRANDON
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State | FL
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Zip | 33511-6007
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Country | US
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Telephone | 813-653-3359
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Fax | 813-662-9639
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MS. COLLEEN CORMAN
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Credential |
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Telephone | 813-653-3359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME56348
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License Number State | FL
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